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New York Opioid Dealer Law – Long Island Lawmaker’s Aggressive Stance

June 14, 2019 By JL Risk Management Consultants

Public Use License NASA Long Island

A suggested New York Opioid dealer law caught my eye as I paged through numerous workers’ compensation articles this week.   A Long Island lawmaker suggested a death sentence for any illegal opioid transactions.

According to the associated article and video:

Long Island Assemblyman Mike LiPetri is proposing a new law that would charge drug dealers with homicide if they illegally sell an opioid to someone who later died from an overdose. LiPetri calls it the “Death by Dealer” law.

The New York State Senate passed the bill, but the State House has not to date.   The bill if passed in the House would not carry a death sentence.  The dealer would be incarcerated with a life sentence. 

A psychologist commented in the article that putting someone in jail for life may not solve anything as the dealer may be in the middle of an addiction to the same opioids. 

Someone from my hometown in Oklahoma was arrested, charged, and convicted of selling part of their opioid prescription to pay for all their prescribed medications.  The sentence was 15 years minimum.  

I usually avoid writing opioid articles.  The Worker’s Comp world has generated almost too many to read in the last few years.   One of the better study and article producers on opioids is WCRI.  Check out their page here for a few recent articles on opioids.

One of the more interesting comments came from one of the manufacturers of a very addictive opioid.  He said the drug would cause a prescription blizzard.   You have to read the article to believe that comment.

The opioid blizzard cost the Federal, state, and local governments $37 billion in lost tax revenue. 

Two interesting articles that I wrote over the years on prescriptions are:

  • Mentally Ill Use 300% More Opioids
  • NSAIDS Provide Same Relief as Opioids

Assemblyman Mike LiPetri’s bill could pass the State House.  I will write another article or update this one if the  New York Opioid Bill becomes law.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: arrested, Death by Dealer, Mike LiPetri, State House

Why Are Workers Comp Pharmacy Benefits So Expensive – In One Picture

October 18, 2018 By JL Risk Management Consultants

Workers Comp Pharmacy High Costs – One Pic Explains It All 

A Workers Comp Pharmacy comparison can be shown in the picture below.    My comparison is not for a Workers Comp claim that I have presently.  Instead, a simple picture shows the source of the high costs of name-brand medications regardless if the benefits are health or workers compensation.   

picture of inhalers from Workers Comp Pharmacy

Taken by article author

The one on the left is brand  name.   The inhaler on the right is a generic version.   Each one of them provides 200 doses.  

Every year, I have to use an inhaler when I catch the usual upper respiratory infection at an airport or in an airplane.  I use air travel just enough to have the usual travel maladies. 

I was explaining to a friend of mine in another country that an inhaler here retails for approximately $175. I will not mention the drug company or the drug in the inhaler.  He said let me check on that as I think they sell here over the counter without a prescription for $4.   I thought he was out of his mind.   

Then, one day I received a package from his present home country.  I will keep the country anonymous as well.  I had remarked to my good friend that the inhaler was running low and I would have to pay for a Doctor’s visit and an extremely high price, even with health insurance, for the inhaler.  

I opened up the package and there was an inhaler from his home country from the same pharmaceutical company.   With postage, it cost him less than $10 including the cost of the inhaler.  

I had thought that it could not be  the same medicine.  I was wrong.  IT WAS THE EXACT SAME MEDICINE manufactured by the same company overseas.  So the inhaler can be obtained without a physician visit in his country – amazing, and it was the dollar equivalent of $4.   

Let us look at the comparison:

  • US – $25 for office visit, $175 (let’s not count in the insurance copay) = $200
  • Foreign country – $4 + 6 postage = $10 
Cash workers comp pharmacy on table

by StockUnlimited

Why does it cost 2,000% more for the same drug manufactured by the same company?  I then honed in on Workers Comp Pharmacy expenditures.   The light bulb went on quickly.   Why are name brand pharmaceuticals so expensive for Workers Comp?  I think it may be that the generics are produced in the same factories as was the inhaler.   

By the way, there is no generic version of the inhaler, unless you live in another country.   Why?   The domestic patent has not expired yet.  

Workers Comp pharmacy costs for the inhaler would be full bore at $175, right?   

I am not a Pharmacy Benefit Manager (PBM) expert.  However, the numbers are the numbers – PBM or not.   If you wish to comment, below, please explain the $173 difference and if the inhaler would be cheaper with a Workers Comp Pharmacy network. 

©J&L Risk Management Inc Copyright Notice

 

Filed Under: pharmacy Tagged With: health insurance, maladies, Pharmacy Benefit Manager

Opioid Study Shocker – Or Was It Really Surprise Conclusion

March 6, 2018 By JL Risk Management Consultants

Opioid Study Shows No Improvement over Nsaids or Acetaminophen

A recent opioid study – great article in the Los Angeles Times – indicated that after a yearlong study opioids showed no great improvement in lessening pain than over-the-counter painkillers.  

chemical diagram of opioid study paracetamol

Public Use License

Another recent study indicated the same result.  I am unable to find that article presently.   Who would have thought that hydrocodone was not more effective than ibuprofen? 

What made this study different was that it was a clinical trial, not just some researchers going through anecdotal data.   The original article from the Journal Of American Medicine can be found here.    I highly recommend reviewing the study abstract – just amazing. 

The clinical trial opioid study involved 240 patients.  This number may seem small.   Then again, the study consisted of a pure clinical trial which hold much more weight with a limited number of patients.  

The findings were:

In this randomized clinical trial that included 240 patients, the use of opioid vs nonopioid medication therapy did not result in significantly better pain-related function over 12 months (3.4 vs 3.3 points on an 11-point scale at 12 months, respectively).

This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

In my personal experience, I had assisted two friends home from outpatient surgeries.  Each of them had a RX for hydrocodone.  It did not lessen their discomfort.   

However, much to my amazement – rapid release acetaminophen had a greater pain-reducing effect.  The rapid release stopped their pain in its tracks after trying a few doses of hydrocodone. 

I published this article on opioids in July 2017.  It is one of the most popular reads when I post it to LinkedIn.  The data in that study showed that a very large percentage of opioid users were actually mentally ill. 

I am sure more studies are planned in this controversial topic.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: acetaminophen, Hydrocodone, Ibuprofen, JAMA

Is This Holy Grail For Opioid Epidemic? (Breaking News)

June 27, 2017 By JL Risk Management Consultants

Use Among Mentally Ill May Be Key To Opioid Epidemic

The opioid epidemic has reached massive proportions over the last few years.   Researchers and pundits searched for the key to why such a high use level among the US and World populations.   

Brain Opioid Epidemic Mental Health

Wikimedia Commons – Patric Hagmann by was_a_bee.

Opioids dominated much of the Workers Comp pharmaceutical discussions for years. 

I came across a research paper and associated article by the Kaiser foundation.  Mental illness affects 16% of the US population.   However, 16% of the population accounts for 51% of all opioid use.

The numbers mean that the population with a mental illness uses opioids at a rate  318% higher than the general population – wow!

One area the article focuses on is that alternative therapies should be the focus of pain reduction – behavioral intervention. 

Study Executive Summary

Background: The extent to which adults with mental health disorders in the United States receive opioids has not been adequately reported.

workers comp opioid epidemic hydrocodone

Wikimedia Commons – Ben Mills

Methods: We performed a cross-sectional study of a nationally representative sample of the noninstitutionalized U.S. adult population from the Medical Expenditure Panel Survey. We examined the relationship between mental health (mood and anxiety) disorders and prescription opioid use (defined as receiving at least 2 prescriptions in a calendar year).

Results: We estimate that among the 38.6 million Americans with mental health disorders, 18.7%(7.2 million of 38.6 million) use prescription opioids. Adults with mental health conditions receive 51.4% (60 million of 115 million prescriptions) of the total opioid prescriptions distributed in the
United States each year. Compared with adults without mental health disorders, adults with mental health disorders were significantly more likely to use opioids (18.7% vs 5.0%; P < .001). In adjusted analyses, having a mental health disorder was associated with prescription opioid use overall (odds
ratio, 2.08; 95% confidence interval, 1.83–2.35).

Conclusions: 16% of Americans who have mental health disorders receive over half of all opioids
prescribed in the United States. Improving pain management among this population is critical to
reducing national dependency on opioids. ( J Am Board Fam Med 2017;30:000 – 000.)

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: Kaiser Foundation, mental disorder, noninstitutionalized, populations

Opioid Statistics – Incredible Numbers From Recent Webinar

January 11, 2017 By JL Risk Management Consultants

Mind Blowing Opioid Statistics

These opioid statistics are astounding and verifiable.  I was listening to a great webinar recording today – See next article.    

Clipart of side view face opioid statistics

123RF

One of the topics was the effect that opioids would have on Workers Compensation in 2017 and beyond.     I was subsequently reading an article on opioids published by Dr. Mercola.  Dr. Mercola has many free publications on health issues.  The article contained incredible opioid statistics.    

Some of the highlights were:

  • Opioids have been identified as the gateway drug to heroin use.   Wow!  
  • More people use opioids than smoke cigarettes.   You have go to be kidding me! 
  • This is not a street-drug epidemic as more opioids are prescribed than bought on the street.  One has to wonder how many car crashes were caused by opioids. 
  • Opioids kill more people every year than car crashes.
  • Many people can become addicted after just one course of opioid treatment 

This last one was a quote from the head of the CDC –  Dr. Tom Friedman  “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”

Percentage Opioid Statistics Vector

Wikipedia – Farmer Jan and bdesham

An earlier  Cutcompcosts.com article pointed out that NCCI had found that 40% of all narcotics are taken by 1% of the Workers Comp patients.    A friend of mine that works the night shift at a large pharmacy in the Boston area says that each night just before midnight, the Vicodin patients line up to get their refills just after midnight.  

She calls it her “waiting room.”   She also says that the numbers each night have been static over the last few years. 

A large number of articles on Workers Comp vs Opioids seem to indicate an improvement in the reduction of abuse.  After reading all these newer articles, it may have shifted from WC, but it is still a problem as proven by the preceding opioid statistics. 

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: Boston, Dr. Mercola, Dr. Tom Friedman, heroin, Vicodin patients

New Mexico Marijuana – Five Joints Per Day Covered By Work Comp

October 6, 2015 By JL Risk Management Consultants

New Mexico Marijuana

Recent New Mexico marijuana laws  have enabled injured workers in the state to consume five joints per day – at a maximum.

Picture Of New Mexico Marijuana Plant

Wikimedia Commons – United States Fish and Wildlife Service

The state of New Mexico has always been very active in their allowance of medical marijuana for workers compensation injuries.

The most recent New Mexico marijuana laws enacted allow for consumption of  up to two pounds per year – and that is to be reimbursed by insurance carriers and self-insured employers.

Two pounds of marijuana equates to five joints per day.  The math  used for conversion from 2 pounds to grams- according to Google- is 907.185 grams.    According to the Denver Post’s 64 questions on marijuana, a PhD, yes, someone with a Doctorate degree figured out that an average joint is  1/2 gram.

So, 907.185 / .5 = 1814 joints per year.   The daily total = 1814/365 = approximately five joints per day.   The cost would be $10,904.54 per year – according to a fellow blogger.

For the average day of 16 hours – that would be a joint every three hours for just one person – and yes, paid by Workers Compensation and indirectly New Mexico employers (directly for self insureds).

As this wades into a political opinion to be drawn, I will not comment on whether I agree or disagree with the new rule that allows this much marijuana to be consumed by an injured worker.  One has to draw their own conclusion.  Feel free to comment on this issue.

©J&L Risk Management Inc Copyright Notice

Filed Under: marijuana, New Mexico Tagged With: Doctorate degree, pounds to grams, reimbursed

Meth vs Opioids in Workers Comp – Hidden Epidemic?

June 23, 2015 By JL Risk Management Consultants

Meth vs Opioids in Workers Comp

Meth vs Opioids in Workers Comp – the silent epidemic is occurring and we may not be looking at what should be considered an even more dangerous line of drugs than opioids.

Picture of Crystal Meth vs Opioids Silent Epidemic

123RF

Opioids are one of the most discussed topics in any analytical setting on Workers Compensation.  I had begun to refer to a great article on opioids when an old friend of mine had informed me that she was getting married to one of my high school classmates.

I brought up the fact that I was writing an article on opioids as we talked.  She is a special education teacher in Dallas, Texas.  She informed that in Texas, Oklahoma,  and most of the rural Southwest opioids pale in comparison to meth and especially a form of it called ice – the smokable meth.

How would she know this – a large % of the special education students she teaches are actually due to the use of crack cocaine and meth by their parents.   Dallas is not a bad city.  In fact, due to the recent oil boom it is one of the most prosperous cities in the nation.

Picture of Meth vs Opioids Mouth Bite

123RF

I do not possess a large amount of facts or figures but Texas, Oklahoma, Kansas, Arkansas, and other Southwestern states are suffering greatly.   As we all know – as society goes, so does Workers Comp.   Meth is much cheaper and actually more accessible than opioids.

One concern is that I do have statistics on opioids, but are there statistics on meth in Workers Comp?  There are studies on most drugs, and unless I am mistaken, little to none on meth.  I must digress to a great article on Workers Comp and opioids.

The article was written by Peter Rousmaniere (in cooperation with WorkCompCentral and CompPharma)  We’re Beating Back Opioids – Now What?   Please note that it is a PDF download.   Peter has performed quite a good bit of research.   I am going to allow myself to take a few liberties and post some of the quotes from the report.

Please note that the PDF is now part of a webinar on opioids.  The PDF is not available. 

Over half of persons receiving 90 days of continuous opioid therapy remain on opioids years later.   This is almost unbelievable.

The nation’s first reported death from prescribed opioids was that of an injured worker, a beneficiary of the Washington Department of Labor and Industries.   This is not surprising. 

In the meth vs opioids in workers comp debate,  one has to look at the future to see that another illicit drug may take the place of opioids for addiction.  I do not think the new replacement drug will be marijuana.

I think the answer to the Now What? part of the aforementioned study is a new illegal drug may be the next “what.”

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: aforementioned, epidemic, illicit, meth, smokable

2014 Workers Comp Prescription Cost Increase – Bargain

April 23, 2015 By JL Risk Management Consultants

2014 Workers Comp Prescription Cost Increase

The 2014 Workers Comp Prescription Cost was actually a bargain when compared to the general public’s cost increase.  The results were totally surprising as I had thought the increases would have been very similar.

Graphic of 2014 Workers Comp Prescription Cost Increses

123RF

The Google search results from link for 2014 Workers Comp Prescription Cost I performed can be followed by clicking on the word the link in this sentence. Update – the link expired – replaced with new link.

 A  Risk Manager from a large governmental organization asked me to include any Google searches that I do for articles when possible.

As mentioned in my previous article on WCRI’s recent release of Medical Cost Containment measures, Indemnity was the original driver for most of the Workers Comp costs.

Medical costs, (especially prescription costs), overtook Indemnity a few years ago and will likely be the main driver of increases in WC payouts for many years in the future.    However,  the overall Workers Comp Prescription cost increase was anemic when compared to the cost burden on the general public.

Pharmacy 2014 Workers Comp Prescription Cost At Pharmacy

StockUnlimited

According to Helios , Workers Comp 2014 prescription cost or prices increased 3.9% over 2013.  According to Express Scripts drug trend report, the increase for prescriptions overall was 13.1% when compared to 2013.

I went to great lengths to make sure that I was not doing the apples versus oranges comparison on the numbers.  There was a plethora of different measurements on the prescription prices increases.

The basis for the Workers Comp increase was supposedly the large increase in prices of generic drugs.  The price increase basis for the general public was due to specialty drugs.  The cost of these specialty drugs increased by an astounding 30.9%

Did Workers Comp PBM’s and medical networks do their job as far as controlling prices increases?  From the numbers, one would have to say yes.

If anyone has a different set of numbers, I am open to adding them into this article as there are a large number of articles with somewhat conflicting numbers.

©J&L Risk Management Inc Copyright Notice

Filed Under: pharmacy, prescription Tagged With: comparison, Express Scripts, prescription cost, public cost

BidRx As Model For Injured Employee Driven Networks

February 11, 2015 By JL Risk Management Consultants

BidRx As A Model For Injured Employee Choice 

One of the most economical websites today is BidRx.  I found it while reading a publication by Clark Howard.  The website was given a thumbs up by the Center for Medicare/Medicaid Services.  (CMS)

One has to have a sponsor when they sign up.  I used CLARK from Clark Howard.  The 5 minute sign up process was very smooth.

Paper of Rx BidRx Vector

StockUnlimited

BidRx  has a few simple steps:

  • Enter in your prescription
  • Pharmacies will bid on your prescription
  • Wait three days to see who is low bidder
  • Pick one of the providers
  • Work out the details

There is really no more to it than the four above steps.  I was very skeptical as a website that sounds too good to be true usually bombs later.

I do realize that there a few Workers Comp websites that provide this service.   However, the ability for the injured employee to do the search on their own may be a good idea.  The results would not be dependent on the carrier or TPA’s network.

This page on BidRx seems to market to physicians.

Economical BidRx prescription

Wikimedia Commons – Linda Bartlett

Last month, I decided to try to see if the website would actually save any money on a generic prescription I had been taking for quite some time.  I filled in the Bid Sheet and waited a day.  Believe it or not, the savings amounted to almost 60%.

One of the interesting quotes on the website is:

Know your patients’ benefit structure and rules

Most patients have drug benefits – of one flavor or another. BidRx shows your patients and their benefits, linked together, so you can make fully informed decisions, for every prescription, every time. BidRx shows you prices, co-payments, discounts, prior authorization (PA) forms that can be completed on-line, and even the availability of product samples. All the information you need is in one place; it’s all on BidRx.

Could this also work for the adjusters?  I am under the impression we will see many more patient-driven medical networks such as BidRx.

©J&L Risk Management Inc Copyright Notice

Filed Under: BidRx, prescription Tagged With: Clark Howard, economical, prior authorization, skeptical

Medical Marijuana Basis For Discrimination Lawsuit

November 12, 2014 By JL Risk Management Consultants

Medical Marijuana Basis For Lawsuit

Medical Marijuana is now a  basis for a discrimination lawsuit.  New Mexico issued a very bad ruling last year that required an employer in the state to pay for a claimant’s marijuana prescription.  This broke through an important barrier where marijuana is accepted as a prescription by the Workers Compensation community.

Picture Of Medical Marijuana Leaves

Wikimedia Commons – United States Fish and Wildlife Service

One had to wonder how long before someone alleges hiring discrimination due to the use of medical marijuana.  Actually, lawsuits have been previously filed in other states that have legalized the use of medical marijuana.

The two differences with this legal action are the state is Rhode Island and the job applicant was a graduate student pursuing an internship.

According to ABC News, a textile company had refused to hire a graduate student for a two-month internship because she uses medical marijuana to treat frequent and debilitating migraine headaches, a decision her lawyer calls discrimination.

The applicant admitted to the textile company’s human resources department that she had a medical marijuana license.  No drug test was ever administered.   The company decided not to offer the internship specifically due to the marijuana issue.

The textile company may have been better served by using another reason to not allow the graduate student to begin her internship.

Medical marijuana will be a popular topic with Workers Compensation over the next few years as more states legalize its use.  It is still considered a controlled substance by the Feds.   Marijuana is still a Schedule I drug as listed by the FDA.  

2020 Update on Medical Marijuana 

Recreational marijuana legalization will likely create more instances of lawsuits due to discrimination for terminating an employee who has tested positive for THC.    THC stays in a person’s system for up to two weeks.  THC is a highly-fat soluble chemical that stores in fat cells for weeks if not months.   

The recreational marijuana enforcement by employers may be worse than the “old days” of being concerned with only medical marijuana. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: marijuana Tagged With: ABC news, Feds, Rhode Island

Top 10 Challenge Areas – Expanded Part I

June 19, 2014 By JL Risk Management Consultants

Top 10 Challenge Areas – The First Five

The article on the Top 10 Challenges for Workers Compensation received a large amount of inter-buzz.

Picture of Man Top 10 Challenge Graphic

(c) 123RF

 Two readers suggested an expansion (better explanation) of my list.   I will split the Top 10 into two articles.

The first five of  My Top 10 areas of challenge are:

  1. Harder market – without investment returns, WC cannot sustain lowering price pressures
  2. Captives/Alternative Insurance – every company wants out of the current WC system 
  3. States that have legalized marijuana – now what does that do for the workplace?
  4. Employers need to monitor next year’s premium
  5. Affordable Care Act- the elephant in the room for any healthcare discussion


Harder Market vs. Hard Market

I rarely disagree with NCCI.  However,  a few weeks ago, the published an article on the underwriting cycle that I did not agree with overall.   Investment returns besides a minuscule rate of rate on interest bearing accounts drive the insurance markets.   To NCCI’s credit, the current situation with a low rate of return (interest) is not enough to sustain a market.  The stock markets have been doing very well.  Other than bonds, carriers can produce a great rate of return on premium dollars invested in the stock market in the long term.

If the stock markets take a hard downturn and the interest rates stay low deflation would rule the day. Carriers have nowhere to go for a decent rate of return.  They will have to look to their policyholders which would equate to a hard market.

Captives/Alternate Insurance

As companies grow, there now seems to be a large push to examine other methods to find WC coverage such as captives, PEO‘s, and small/large deductibles.   Alternative insuring arrangements does carry a large risk especially if a company is going to retain a large amount of the premiums.   The alternative market must be examined with caution.

 States That Have Legalized Marijuana

Gavel top 10 challenge with court paper

Wikipedia – Jonathunder

Two recent New Mexico court decisions have shined a bright light on the problem of marijuana in the workplace.  California issued a similar decision a few years ago.  If marijuana is prescribed medication by a physician, will it be considered the same as any employee that happens to be taking a prescription while on-the-job?   Will an employee file a “drug discrimination” grievance in that instance?

Employers Overpaying Premiums At Policy Inception

 There are many articles in this blog concerning the level of payroll decreasing for certain employers.   If your company has a 20% reduction in workforce, why would you pay the same premium base as last year?

Affordable Health Care Act

As I have written so much on this subject, I will refer to this article (click on the heading) on how the changes in healthcare will affect WC.

©J&L Risk Management Inc Copyright Notice

Filed Under: captive, hard market, marijuana, Obamacare Tagged With: alternative insurance, investment, legalized, overpaying

New Mexico Shocker – Rocky Mountain High – Dangerous Barrier Broken

May 22, 2014 By JL Risk Management Consultants

Rocky Mountain High – In New Mexico

A New Mexico Court of Appeals has recently ruled that an injured employee’s Workers Compensation carrier must pay for his marijuana prescription.  The ruling even noted the federal laws for medical marijuana would prohibit the use.

Picture Of New Mexico Rocky Mountain High

Wikimedia – Decumanus

According to the Santa-Fe New Mexican, The New Mexico court on Monday upheld a decision by a workers’ compensation judge that medical marijuana was “reasonable and necessary medical care” from a health care provider under terms of workers’ compensation law.

One thing that I noted from most of the buzz (no pun intended) was how well this was covered in all the Workers Comp press.  The Santa-Fe New Mexican also noted that the worker had a 99% disability – how does one get a 99% but not 100% – interesting.

The dangerous barrier that this could have broken in being stoned while on the job.  Over the years, I have paid and watch insurance companies lose in the courts over whether or not the alcohol or marijuana was “the proximate cause of the accident.”  

Did the New Mexico Court of Appeals just allow an avenue for marijuana to be used on the job by anyone that has a medical marijuana card?  The conundrum will not be the worker using it while on the job.   However, will a positive marijuana test hold any water to deny a claim if the person happen to have a marijuana card?   They are not that hard to obtain.  Try weedmaps.com to find the nearest Dr. that will write you a RX for pot. 

Rocky Mountain New Mexico And Lake

Wikipedia – Gorgo

Many years ago, I denied a claim due to a worker falling through an open skylight and falling in a bathtub.  The spinal injury was minor, however, the area was taped off with that “DO NOT CROSS” yellow tape that he had to break to make it to the skylight.   

These are two articles that I previously wrote about marijuana.  Check here and here.  There is going to be a rush of articles in the news on this ruling and every time there is a decision on medical marijuana.  

I will try to keep the blog updated on these New Mexico and other rulings. 

©J&L Risk Management Inc Copyright Notice

Filed Under: marijuana, New Mexico Tagged With: court of appeals, dangerous, health care, Santa Fe, weedmaps

WCRI Study – Louisiana New York Have Highest WC Opioid Use

May 15, 2014 By JL Risk Management Consultants

WCRI Study

Oklahoma recently enacted new rules for opioid use as 8% of the general population were long term users of painkillers.   WCRI recently performed a startling study on Workers Compensation opioid use which indicated that Louisiana and New York injured workers were ingesting massive amounts of opioids.  

Spilt bottle WCRI of medicine

StockUnlimited

The WCRI study was titled – Interstate Variations in Narcotics Use – 2nd edition.   Graphics are usually not in the article on this blog.  However, the graph at the end of this article is “worth a thousand words.”  The graph below says it all concerning opioid use.  

I usually do not like to cut/past right out of press releases, but WCRI’s Dr. Victor said it better than I could on WC opioid abuse.  The complete study is available here.   If you are a risk manager, adjuster, or anyone involved with WC claims, this is a very thorough study that should receive your attention.  

The dangers of narcotic misuse resulting in death and addiction constitute a top priority public health problem in the United States and are shared by the workers’ compensation community,” said Dr. Richard Victor, WCRI’s executive director. “This study will give public officials, employers, worker advocates, and other stakeholders the ability to see how the use and prescribing of narcotics in their state compares to others.” 

According to the study, the average injured worker in New York and Louisiana received over 3,600 milligrams of morphine equivalent narcotics per claim (double the number in the typical state). To illustrate, this amount is equivalent to an injured worker taking a 5-milligram Vicodin® tablet every four hours for four months continuously, or a 120-milligram morphine equivalent daily dose for an entire month. 

Besides New York and Louisiana, the amount of narcotics per claim was also higher in Pennsylvania and Oklahoma (32–48 percent higher than the typical state). Michigan had the highest amount of narcotics per claim among the Midwest states included in this study. It is worth noting that Michigan was among the states with lower use of narcotics per claim compared with the typical state in 2008/2010. 

The study found that narcotics are frequently used in the workers’ compensation system. In 2010/2012, about 65 to 85 percent of injured workers with pain medications received narcotics for pain relief in most states. A slightly higher proportion of injured workers with pain medications in Arkansas (88 percent) and Louisiana (87 percent) received narcotics. 

The study is based on approximately 264,000 workers’ compensation claims and 1.5 million prescriptions associated with those claims from 25 states. The claims represent injuries arising from October 1, 2007, to September 30, 2010, with prescriptions filled up to March 31, 2012. The underlying data reflect an average of 24 months of experience. 


The following states are included in this study: Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Average of WCRI Equivalent Amount Per Claim Emblem From Web

©J&L Risk Management Inc Copyright Notice

Filed Under: Louisiana, New York, Oklahoma, Opioid, Pennsylvania, WCRI Tagged With: average, interstate variations, narcotic, Narcotics, typical state

Four Popular WC Medications That Are Becoming Generic

May 9, 2014 By JL Risk Management Consultants

Four Popular WC Medications > Generic 

There are presently four popular WC medications that are becoming generic in the next few months.  The NAMSAP (National Association Medicare Set Asides Professionals) conference in Las Vegas has provided me with a vast amount of new information on MSA’s.  

NAMSAP Four Popular WC Medications Emblem From Web

(c) NAMSAP

Dr. Marcos Iglesias, Midwest Employers Casualty, presented on the medication component of MSA’s.  One of the interesting parts of his presentation was the four medications that are very popular with WC injured workers are now going to be generic in the near future.  The four popular WC medications are:

  • Nexium – May 2014 (AstraZeneca)
  • Lunesta – May 2014 (Sunovian)
  • Exalgo – July 2014 (Mallinckrodt)
  • Celebrex – December 2014 (Pfizer)

The initial manufacturer of medications that are deemed generic (lose their patent) is often Teva Pharmaceuticals.  Teva is a very popular manufacturer of generic medications.  

 

Exalgo was one that I had not seen that much in any of the WC files we have reviewed over the past few years.  Exalgo is basically an extended release opioid.  Celebrex would be the most popular that I have seen out of the four listed meds.    

 

Many of the pharmaceutical companies will file multiple lawsuits against any of the generic manufacturers as they do not wish to lose their patent. 

 

If you are involved with any MSA’s one component to examine for future medical expenditures is the medications the injured worker is taking may not be the higher-priced brand name forever.  Knowing the date when a patent expires can reduce the future med costs extensively. 

©J&L Risk Management Inc Copyright Notice

Filed Under: generic, NAMSAP Tagged With: Celebrex, Exalgo, Lunesta, medication, MSA, Nexium, pharmaceutical, Teva

One Of Most Trusted Medical Professionals By Injured Workers

February 27, 2014 By JL Risk Management Consultants

Highly Trusted Medical Professionals Include Pharmacists

Pharmacists have always ranked very high on the list of Trusted Medical Professionals.  Almost 73% of a recent survey’s respondents listed pharmacists as a very trusted professional.  Only nurses were ranked higher.

Picture of Trusted Medical Professionals Shake Hand

(c) 123rf.com

Since the late 1980’s Gallup has created a poll asking the public to rank the most trusted professionals.  As one might expect, Congress and car salespeople ranked the lowest.   Why would pharmacists be so highly trusted?

A pharmacist that actually sits on a state review board said that most people will tell their pharmacists things they may not even tell their physician, spouse, or clergy.  According to this article,  pharmacists:

  •  Usually have a long patient-professional relationship with their customer
  • Are much more accessible than most medical professionals, most are available 24 hours a day
  • Weigh out the cost of  medications for a particular customer
  • Are very unbiased in their opinions on medications and ailments
  • Spend longer with their customers than the average 12 minutes that a physician spends with their patients

How does this relationship affect Workers Comp?

  • Picture Male Trusted Medical Professionals Lab Worker

    123RF

    Mail order is great for cost savings but has the pharmacists at a distance

  • It may be wise to authorize a local pharmacist to fill prescriptions
  • Introduce or maintain an element of trust while disabled or treating for a WC injury
  • Claims staff and employers should look to work with the pharmacist especially when receiving an authorization call  from a pharmacy
  • Pay RX reimbursements from injured workers ASAP
  • Find out if the local pharmacist is part of a WC network.
  • Claims staff can ask for generic equivalents when the pharmacy calls for authorization.

One final note is there is nothing wrong with mail order prescriptions.  However, the face-to-face interaction between an injured worker and their pharmacist is very important in their recovery.

©J&L Risk Management Inc Copyright Notice

Filed Under: pharmacy Tagged With: generic equivalents, medical professional, medication, patients, relationship

Oklahoma’s New Anti Drug Abuse Bill Will Affect Workers Compensation

February 26, 2014 By JL Risk Management Consultants

Oklahoma’s New Anti Drug Abuse Bill vs. Work Comp

Oklahoma’s  new anti drug abuse bill should affect WC. Oklahoma Governor Mary Fallin has given her blessing to a new bill that would limit the use of painkillers by requiring physicians to access a database to check on the prior prescriptions of a patient.

Obamacare Anti Drug Abuse Bill Logo

Wikimedia Commons – Obama

A surprising statistic is that 8% of all Oklahomans abuse some type of painkiller.  

The national average is 4%.

Oklahoma articles always pique my interest as I am originally from there.  Drug abuse of many types have been rampant in my home state since the 1960’s.   One reason, in my opinion, is that so many jobs are extremely laborious in the oil and gas industry.   Many oil and gas workers experience chronic back injuries.

If the bill is voted in and signed into law, this will also help control WC costs.  If a WC patient can be monitored for prior prescriptions, then the additional cost of the abused prescription medications along with the lengthened disability period should be reduced sharply.

Assuming that the same of number of WC patients also abuse painkillers (opioids), then an 8% or more reduction in WC costs on medical payments would be incurred by the insurance carriers. However, drug treatment programs for WC patients may spike if abusers are identified by the database and the physician requests a detox program.  One could also assume the number as being much higher for WC patients.

Graphic Oklahoma Anti Drug Abuse Bill vs. Work Comp

StockUnlimited

There are many questions about the database and how it would function with WC benefits:

  • How will the Dr. handle the patient that has too many recent painkiller prescriptions?
  • Will the claims department be notified of any drug-abusing patient?
  • Can the patient just go across state lines to get an additional RX?
  • Will this system also be available to pharmacists as a backup deterrent?
  • Can the adjuster log into the same system? (probably not)
  • How will HIPPA and the Affordable Care Act affect this new law?
  • Can a Dr. override the system or ignore it and prescribe opioids regardless?
  • Will the Oklahoma legislature also require this on WC injured workers?

I will write another article on this bill whenever it becomes law.   This is a step in the right direction for Oklahoma.

©J&L Risk Management Inc Copyright Notice

Filed Under: Oklahoma, Opioid Tagged With: detox program, drug abuse, HIPPA

Job Alcohol v. Marijuana Debate – A Great Article Readers Question

January 28, 2014 By JL Risk Management Consultants

On The Job Alcohol v. Marijuana Debate

The Job Alcohol v. Marijuana debate usually ends up with an interesting discussion.   The job alcohol v.  marijuana debate pits the right to privacy against the right to a safe workplace. 

Vector Graphic of Job Alcohol v. Marijuana Debate Icon

StockUnlimited

A very interesting question popped up on the LinkedIn Work Comp Analysis group concerning marijuana a few days ago.   As you probably have heard by now, President Obama had said that marijuana is no more harmful than alcohol.  This immediately started a debate of which is worse – alcohol or marijuana.

One important point is the President did not say that pot was safer than alcohol.  He basically said that it is no worse than alcohol.  He did not say it was safer or more dangerous.   Taking his comments one step further, should marijuana ever be excused if detected in a pre-employment or post-accident drug test?

According to most of the literature on marijuana, the most active ingredient THC stores in the body’s fat cells for quite some time after ingestion.  This is the main difference which is going to be a tough area for on-the-job decisions on WC claims.

Many years ago, I was adjusting a claim where a roofer fell through an open skylight that was taped off using something similar to the yellow police tape.   The claim was denied with the green light to take it to a hearing.  Even though the worker was shown to be as high as a kite, the WC court decided to rule for benefits.   That was the first denial I ever issued for pot.

My main point in denying the file was the yellow police tape being around the open hole in the roof.  The employer decided it was best along with counsel to not appeal the case.  They did not want to write bad appellate law if the case was lost on appeal.

Graphic Of Marijuana Leaf Job Alcohol v. Marijuana Debate In White Background

StockUnlimited

The one pattern I noticed on the responses to the LinkedIn question was the lack of knowledge concerning marijuana.  I wanted to say up front that I am not a marijuana advocate or user.   Some of the better sources for marijuana analyses are at these websites:

  • Drugs.com is one of the better drug interaction websites.  Their marijuana info is here.
  • CNN’s Dr. Gupta wrote an interesting article on marijuana.  Check it out here.
  • From the Centers for Disease Control (CDC), a study on drug levels in suicide victims is here.   The only drawback to this study is the disclaimer is as long as the study.
  • This is actually the Whitehouse’s opinion on marijuana.  See it here.

Two states (Washington and Colorado) have actually decriminalized pot.  However, I do not think any state will change their views on WC laws as it pertains to weed.

This debate will go on for decades as more states such as California, Hawaii, and others attempt to fully legalize marijuana.  We are unlikely to hear the end of the Job Alcohol v. Marijuana debate any time soon. 

©J&L Risk Management Inc Copyright Notice

Filed Under: marijuana, Washington Tagged With: CNN, debate, drugs.com, THC

PMSI Progressive Medical Merger – Small WC Companies Fading?

September 10, 2013 By JL Risk Management Consultants

PMSI and Progressive Medical Merger Causes Workers Comp Buzz

PMSI and Progressive Medical Merger shows that small WC companies  may not exist much longer in the insurance landscape.  The buzz at the end of last week and over the weekend was the surprising merger of two Workers Comp service titans.  

Picture Of Couple With Progressive Medical Merger Financial Advisor

StockUnlimited

The merger actually made sense from a financial standpoint as these two companies’ lines of service will complement each other very well.

The WC ancillary service market has long been contracting to a few major players.  The buyout and merger fever may just be a premonition of the future.

If one wanted to survey the “new” Workers Comp landscape, they had to look no further than the 2012 LRP Las Vegas conference.  Many of the booth workers had commented they were being bought out or had just acquired some type of ancillary service company.

PMSI was one of the WC originals for prescriptions, TENS units (are they still in use?), durable medical equipment, and other related services.  PMSI had and has always done a great job of face-to-face marketing.

Progressive Medical seemed to be one of the “late entrants” into the ancillary services market.  However, their stellar PBM services were cutting edge at the time.   The press release for Progressive Medical can be found here.   For convenience the press release on Progressive’s website is presented below.

Progressive Medical and PMSI announced today that the two companies have entered into a definitive agreement to merge. The transaction is expected to close in the fourth quarter subject to receipt of regulatory clearance. The combined company, which will be led by Executive Chairman Eileen Auen from PMSI and Co-CEOs Emry Sisson and Tommy Young from Progressive Medical, will deliver comprehensive workers’ compensation pharmacy benefit management services including end-to-end pharmacy, ancillary and settlement solutions.

Picture Of Two Businessman Shake Hands Progressive Medical Merger Agreement

123RF

“Bringing together the resources and deep industry expertise of these two companies will enable the combined organization to continue to drive product innovation in the workers’ compensation marketplace while delivering operational and service excellence and ever improving clinical and cost containment services to our clients,” said Tommy Young, Co-CEO of Progressive Medical.
Eileen Auen, Chairman and CEO of PMSI, stated “The PMSI leadership team is delighted to partner with Progressive Medical. We will continue to deliver customized solutions to our clients, and I am personally excited about working closely with the combined team to bring unique solutions to our customers.”

“This merger will drive increased efficiency in the workers’ compensation business,” according to Emry Sisson, Co-CEO of Progressive Medical. “We will strategically leverage the capabilities of the combined organization to bring even greater value to our customers.”

Funds managed by Kelso & Company have agreed to acquire a significant ownership stake in
the combined company. StoneRiver Group, the controlling shareholder of Progressive Medical,
will continue to be a significant shareholder in the combined business.

©J&L Risk Management Inc Copyright Notice

Filed Under: Las Vegas, LRP, pharmacy Tagged With: ancillary, CEO, equipment, merger, PMSI, Progressive Medical, TENS

Florida Physician Dispensaries Opt Out Of Opioids Due To Ban – WCRI

July 17, 2013 By JL Risk Management Consultants

Physician Dispensaries Opt Out Of Opioids – A Good Sign

Physician dispensaries Opt Out due to a strict ban in Florida    Florida has endured an epidemic of the improper use of opioids. They have been discussed to the nth degree in Workers Compensation.  

Resperine Physician Dispensaries Opt Out prescription

Wikimedia commons – Linda Bartlett

One of the most prevalent voices against improper use of opioids has been Mark Walls in his  Workers Comp Analysis Group  on LinkedIn .  The group has many articles and discussion on opioids.  If you have not joined the group, you are missing out on the hot topics in WC. 

The State of Florida decided to ban WC physician dispensing on opioids that was likely due to numerous television shows on pill mills in Florida.  Florida sometimes seems to come up with very bad rulings on WC cases.  However, this was a great way to cut opioid use. 

What do you think happened?  According to WCRI in its very informative report , Impact of Banning Physician Dispensing of Opioids in Florida , when opioids are banned, the physician dispensers switched away from opiates.  The physicians also substituted in non-opiates instead of writing a RX to be dispensed at a pharmacy.  

The lingering questions would be  – why did the doctors prescribe opioids in the first place? 

According to the study, “The ban on physician dispensing of stronger opioids, House Bill 7095, went into effect July 1, 2011.  The study examined the medical care received by injured workers with injuries occurring prior to the law change and after the law change. Patients’ prescription histories were analyzed for the first 3–6 months after the injury. “

Medicine Physician Dispensaries Opt Out Picture

Wikimedia commons – en:User: Sponge

Some of the highlights from the study were:

  1. The study found a high rate of physician compliance with the ban. The percentage of workers receiving stronger opioids was 14.5 before the ban. This fell after the law change to 12.4 percent. 
  2. There was an increase in the percentage of patients receiving physician-dispensed nonsteroidal anti-inflammatory medications (e.g., ibuprofen, naproxen sodium)—from 23.8 percent of patients to 26.0 percent. 
  3. “If this evidence is correct, it could shift the policy debate from whether or not there are substantial benefits to some patients from physician dispensing, to whether or not there are substantial harms to some patients from physician dispensing,” said Richard Victor, WCRI’s executive director. 
  4. Victor cautioned that the results from this study are not definitive and could also be consistent with several other possible explanations.  WCRI is planning an additional study that examines patients at a greater length of time from injury to provide more definitive information.

The next opioid study by WCRI should be very interesting as more data points can be obtained from the prescribing information.    

©J&L Risk Management Inc Copyright Notice

Filed Under: Florida, Opioid Tagged With: epidemic, Mark Walls, Workers Comp cases

Opioids – Oxycodone and Hyrocodone Gain In Popularity

January 3, 2013 By JL Risk Management Consultants

Generic Opioids Gain In Popularity- Oxycodone

Opioids have been on the Workers Comp radar screen over the past few years due to their abuse and dependency by injured workers.  Hydrocodone (Vicodin) seemed to be the most popular according to the pharmacists that were contacted in 2011 and early 2012.

White Opioids Vicodin tablet

Wikimedia Commons – dea.gov

Vicodin is so addictive that people would actually line up to get their prescriptions just after midnight upon renewal of their 30 day Rx.   Workers Comp was no different as there seemed to be a trend towards long-term heavy usage.

According to two pharmacists I talked with in December 2012 (one works the night shift 11PM – 7AM), Vicodin is now much less prescribed likely due to its horrendous effects on the stomach.  In fact, the night-shift pharmacist indicated that 30mg Oxycodone is the #1 drug dispensed during his/her shift.    

One of the most intriguing aspects is that Hydrocodone/Vicodin is a very strong compound.  However, the dosages are much smaller than when compared to Oxycodone/Percocet.  Both pharmacists pointed out that Oxycodone can be prescribed up to a 30mg dose.  Even though Vicodin is stronger (7.5 mg Vicodin = 10mg Percocet),  the largest dose of Vicodin available is 10mg.

Picture Opioids Pills

StockUnlimited

Using a very quick math formula, 30mg of Percocet would equal 22.5mg of Vicodin or over two doses.

Due to bad press, OxyContin is now not as popular as in the past.  OxyContin is actually just time- released Oxycodone.

The bottom line is that Oxycodone is very popular now as the dosage can be up to 30mg.   That is a large amount of immediate-release medication.  Oxycontin can be found in 165mg dosages, but it is a time-released opioid.

The FDA is now becoming more involved in opioid education.  The FDA seemed more interested in educating consumers on extended release or long-acting opioids.  They may want to add Oxycodone to the list.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: injured employee, Percocet, prescription drug

Workers Comp Narcotics – When Does 1% Equal 40% ?

June 5, 2012 By JL Risk Management Consultants

Shocking Statistics on Workers Comp Narcotics

The NCCI just released a study today on Narcotics in Workers Comp. The buzz on narcotics/opioids almost rivals fraud. I decided to read the study closely to see if there were any astounding facts.

Picture of Medicines narcotics assorted Capsules and Tablets

(c) 123rf

The one statistic that stood out was that 40% of all narcotics in Workers Comp are consumed by 1% of the injured employees. I thought about this stat for a few minutes and came to the conclusion this was true Workers Comp sticker shock.

Along the same lines, but not as severe, 80% of all narcotics in Workers Comp is consumed by 10% of the injured employees. The report went on to say that the numbers have actually fallen a small amount over the last few years. That is amazing to me.  

As expected, Oxycontin(r) and its generic equivalent were the most prevalent narcotic. Oxycontin and its generic was the most used narcotic in 2003. Its popularity waned. However it is now the ranked #1 again for narcotic use in Workers Comp.

I wrote about the abuse of Fentanyl in California’s WC system a few months ago. There is now even a stronger replacement for Fentanyl called Fentora. I recommend clicking the above link on Fentanyl. It is an eye-opener.

The concern is that Fentora is much stronger than Fentanyl as the dose has to be reduced when compared to Fentanyl before taking it. Fentanyl is actually 75 to 100 times stronger than morphine.

Graphic Skull Made Up Capsule Narcotics Pills

StockUnlimited

Alaska’s generic only rule in 2008 was seen as a bold move and a way to cut Workers Comp prescription costs. Oxycontin and Fentanyl/Fentora have generic equivalents. This type of rule would not eliminate narcotics being used by injured employees. Would a Pharmacy Benefit Management (PBM) program be the way to handle this conundrum?

I had seen a posting or an article somewhere today that indicated the injured employees that are taking such powerful narcotics for pain management do not ever return to work. I will find that article this evening and post on it tomorrow.

©J&L Risk Management Inc Copyright Notice

Filed Under: NCCI, Opioid Tagged With: fentanyl, Fentora, narcotic, oxycontin

Opioid Abuse In Workers Compensation

February 9, 2012 By JL Risk Management Consultants

Opioid Abuse

The growing problem of Opioid abuse in WC. This subject has been covered very well in Mark Wall’s Group on LinkedIn – Work Comp Analysis Group. If you are a member of LinkedIn, I highly recommend joining the group. I cannot link directly to the group as it is password protected. 

Picture Of Medicine Opioid Abuse

StockUnlimited

Opioid abuse in Workers Compensation is a growing problem. It is more of a societal problem than just Workers Comp. Last night, I was watching a program on NatGeo called Pill Nation. It was mortifying as I was shocked at how out of control the pharmaceutical management system has become over the last few years.

There is a short clip of one of the Oxycontin addicts. Brace yourself if you want to watch it here. The clip is a little unsettling. The show will be on a few times until Sunday. It is worth watching. I do not usually recommend watching any TV shows. This is an exception.

The bottom line of what I saw was that Oxycontin abuse is running amok in Florida as there is no system in place that tracks the prescribing of narcotics. Until legislation is put in place that will stem the abuse, Florida will be the source for illegal Oxycontin for years to come.

Picture Capsule Opioid Abuse Concept

StockUnlimited

The one narcotic that seems to be the most abused on the claims that I have seen is Vicodin. I posted in Mark’s group a few weeks ago on Vicodin abuse level. I know of a pharmacist that works the night shift in the northeastern US. The Vicodin users line up a few minutes before midnight so that when the abuser’s RX rolls over into another 30 days, they are at the counter at that moment. There have been two robberies at the store where she works – both for Oxycontin – but no cash was taken.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: mortifying, password protected

Fentanyl Shocker – Popular Pain Med?

May 10, 2011 By JL Risk Management Consultants

Popular Pain Med Fentanyl

The popular pain med fentanyl CWI California was shock.This very dangerous medication hit the Workers Comp airwaves late last week. An article was published by the California Workers Compensation Institute which indicated that Fentanyl was being prescribed more regularly by certain California physicians as a pain killer.

Graphic of Different Medicines Popular Pain Med Fentanyl

(c) 123rf.com

Fentanyl is one of the most powerful narcotic drugs on earth. It is usually prescribed in a patch form. I had seen two different medical shows where someone had died due to a breathing failure when they accidentally put on two patches – both times after waking in the middle of the night and forgetting they already had on a patch. According to the CWCI article, Fentanyl is 75 to 100 times more potent than oral morphine.

 According to the CWCI study, $86 million dollars was spent on Fentanyl from Jamuary 2006 to December 2009 on just Workers Compensation prescriptions. CWCI’s research series has shown that the 10 percent of physicians who write the most Schedule II opioid prescriptions for injured workers in California are associated with 79 percent of all workers’ compensation prescriptions for these types of narcotics, and for 84 percent of the fentanyl prescriptions.

 I am not saying that fentanyl does not have its place in treatment. As I have posted very often, why I post on any California issues is that with Workers Comp, what happens in CA will be coming to your state soon.

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: Fentanyl CWCI California, Narcotics, oral morphine, painkiller

Proximate Cause – Does A Bear Smoke Pot In The Woods?

June 8, 2010 By JL Risk Management Consultants

Drugs vs. Proximate Cause

The proximate cause of an accident may not always be that obvious in a WC claim.

One area that Workers Comp insurance companies and self insureds spend a large amount of money to deny and defend claims is when an injured employee is deemed to have alcohol or drugs in their system. Many employers, TPA, and insurance carriers have a rude awakening when the employee is awarded benefits by their respective Workers Comp Commission.

Picture Of Drugs Proximate Cause In Bottle

StockUnlimited

I do not agree with the premise, but this happens often. Before a denial is issued the carrier, employer or TPA, the question has to be asked – Was the drug or alcohol in the employee’s system the proximate cause of the incident?

One of my first denials that was lost at an Industrial Commission hearing when an employee that was stoned on pot and fell through an open skylight into a bathtub. The file was denied and defended. The Deputy Commissioner awarded benefits as the PROXIMATE CAUSE of the accident was not due to the marijuana intoxication of the employee.

OK, back to the title of this post. Recently, in Montana, a worker at a tourist attraction was mauled by a grizzly bear while on the job. The worker had smoked pot just before beginning work. The worker had to enter a bear cage and was mauled by the bear.

The employer had denied the incident saying the employee was a volunteer and the fact that he smoked pot caused the accident. The Workers Compensation judge did not see it that way and awarded benefits. The judge also concluded that the proximate cause was not the worker having smoked pot.

©J&L Risk Management Inc Copyright Notice

Filed Under: marijuana Tagged With: grizzly bear, intoxication, skylight

Most Popular Prescription Drug Shows Alarming Trend

May 28, 2010 By JL Risk Management Consultants

Most Popular Prescription Drug Was An Opioid?

The most popular prescription drug was one that I have taken myself a few times over the years.  Statins were very popular at one time.  Stomach and digestion remedies dominated the requested prescriptions decades ago. 

I was just reading an article in Forbes Magazine. The most popular drug prescribed today is Hydrocodone – better known as Vicodin. I am sure that everyone involved with Workers Comp has seen this drug often prescribed for any type of pain. As it is generic, it is a very low priced drug.

Graphic Of Popular Prescription Drug Rx

StockUnlimited

I looked to see if Hydrocodone was included in any of the $4 prescription programs.  I checked here with Walmart to see if they have it in their $4 list.  It was not.

Hydrocodone seemed to be very popular a few years ago in Workers Comp. I have two friends that are Pharmacists. One of them works the night shift. They both say that it is the most heavily sought out drug for drug seekers, especially at night. Many people have stomach problems as it is so harsh to the system.

The most disturbing fact about Hydrocodone is a panel of FDA advisory physicians recommended an immediate ban on the drug. The FDA is waiting to see what to do on the matter.

What to do? Their own advisory panel said to ban it. What are they waiting on to close the drug down?

©J&L Risk Management Inc Copyright Notice

Filed Under: Opioid Tagged With: Forbes Magazine, Hydrocodone, prescribe

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James J Moore
Raleigh, NC, United States

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:
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Recent Posts

  • AIC Designation Changes – One Major Modification To Study Guides
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  • Coronavirus Vaccine Journey – Second Act – Over in 30 Minutes
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  • How Microcaptive 831(b) Arrangements Were Disrupted This Month
  • My COVID-19 Vaccination – Among The Everyday Heroes
  • WCRI 2021 State of the States Presentation – The Past Rules
  • Back To Work During A Pandemic For The Employee – Another Look
  • WCRI COVID-19 Impact and Effect on Claims and Medical Treatment
  • WCRI Session That I Attended – Shocking Topicals Numbers
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Raleigh, NC 27614
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